2. Reimbursement
(Inpatient or Outpatient)
5 You will only need to file for reimbursement
if you seek treatment as a Private Patient
and pay up front, versus seek treatment as
an HMO Patient and not pay at all, because:
5 1) you want to be treated by a non-accredited doctor; and/or
5 2) you want to be treated in a non-accredited hospital/clinic.
5 To get reimbursed, fill out the proper claim
form, complete all the requirements, and
submit all the documents.
5 For pick-up of your claims documents in
Manila, please call Lala (888-0001 ext. 835).
5 Outside Manila, please send via LBC to:
GRA (attention: Purple Cow)
15/F Chatham House, Salcedo Village,
Makati City
5 The standard wait period for reimbursement
of claims is fifteen (15) working days.
3. Outpatient Claim Checklist
Submit accomplished ‘Out-Patient Claim Form’
To be accomplished & signed by the Employee AND
the attending physician
To be submitted to HR
ORIGINAL of the following should be submitted:
Official Receipt(s);
Prescription for the diagnostic test(s);
Medical Certificate in the absence of Out-Patient
Claim Form but insured still has to accomplish the
Out-Patient Claim Form
4. Inpatient Claim Checklist
5 Submit accomplished ‘Hospitalization
Claim Form’
Part 1 - by the insured
Part 2 - by the authorized HR officer
Part 3 - by the ATTENDING physician
5 ORIGINAL of the following should also be
submitted:
Official Receipt(s) bearing ‘BIR Permit
Number’
Hospital bills,
Professional Fee(s)
Medicines bought outside the hospital but were
consumed during confinement
Statement of Account (SOA)
Itemized list of expense, Charge Slips
Police Report, when necessary
